An assisted reproduction technique used to overcome male infertility is increasingly being used to treat couples who may not need it, say US researchers. Dr Tarun Jain and his colleagues, based at the University of Illinois at Chicago, say that the use of ICSI has become standard practice in many fertility clinics - even when men have no sperm problems. The study, published in the New England Journal of Medicine, found that by 2004, nearly 58 per cent of IVF procedures carried out in the US involved ICSI, while the rate of male infertility has remained constant at around 30 percent.
ICSI treatment is a variation of IVF in which a single sperm is injected directly into an egg. It was developed as a way to help men with very low sperm counts to have a genetically related child. However, the latest study shows that since 1995, its use has increased dramatically in the US, to include patients for whom its use was intended. 'Despite its added cost and uncertain efficacy and risk, the use of ICSI has been extended to include patients without documented male-factor infertility', said Dr Jain.
The researchers analysed national assisted reproduction data collected during 1995-2004, which included all IVF cycles carried out using non-donor eggs in women younger than 43. The percentage of cycles using ICSI increased from 11 to 57.5 per cent during this time, while the percentage of couples diagnosed with male factor infertility remained constant. The team also found that states with compulsory insurance cover for infertility (Illinois, Massachusetts and Rhode Island) had a greater use of ICSI than states without compulsory insurance cover.
Dr Jain says that more research is needed to find out if such frequent use of ICSI is a good idea. Although doctors may believe that it increases their patients' chances of conceiving, there is no real evidence that it does so, he says. Some doctors may feel that ICSI is appropriate for couples who have had repeated IVF failures, or for those who have very few eggs available, for example.
Jain concludes that 'further studies are needed to better understand the proper role of ICSI , and perhaps guidelines may be useful to determine what the best indications are for use of the technology in patients without male factor infertility'.